Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral

Amat‐Santos, Ignacio J.; Rojas, Paol; Gutiérrez, Hipólito; Vera, Silvio; Castrodeza, Javier; Tobar, Javier; Goncalves-Ramírez, Luis Renier; Carrasco, Manuel; Catalá, Pablo; Román, José Alberto San

doi:10.1002/ccd.27485

Cited by 43 publications

(19 citation statements)

References 43 publications

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“…Guidewire (E) and short sheath insertion (F). implantation, major vascular complications, and acute kidney injury requiring dialysis when compared to the TF approach [24] .…”

Section: Discussionmentioning

confidence: 99%

“…Amat-Santos also suggested that, despite a higher logistic EuroScore (23.7±1.92 vs . 21.17±3.51; P =0.04) and more prevalent coronary and peripheral artery disease, TAx access was performed with a similar 30-day stroke rate, need for new pacemaker implantation, major vascular complications, and acute kidney injury requiring dialysis when compared to the TF approach [ 24 ] .…”

Section: Discussionmentioning

confidence: 99%

“…A totally percutaneous axillary approach was described for the first time in 2012 by Schäfer et al [9] in a cohort of 24…”

Section: Percutaneous Axillary Artery Approachmentioning

confidence: 99%

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The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures

Tagliari¹,

Saadi²,

Ferrari³

et al. 2021

Braz J Cardiovasc Surg

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With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVIeligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.

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“…Guidewire (E) and short sheath insertion (F). implantation, major vascular complications, and acute kidney injury requiring dialysis when compared to the TF approach [24] .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures

Tagliari¹,

Saadi²,

Ferrari³

et al. 2021

Braz J Cardiovasc Surg

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“…Smaller published series have demonstrated similar results. 28,29 Transcarotid Mylotte et al described a large series of transcarotid TAVI, with 96 patients undergoing the procedure in three high-volume TAVI centres in France over 4 years (2009-2013). 30 The patients included in this registry had small-calibre, heavily calcified, tortuous or stenotic iliofemoral anatomy or significant descending aortic pathology.…”

Section: Trans-subclavian/transaxillarymentioning

confidence: 99%

Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

Coughlan

Kiernan

Arnous

2019

Vascular and Endovascular Review

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Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.

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“…As highlighted by the authors (and this is the main message from this work, from my perspective), we need to start wondering which alternatives are preferred by well-informed patients; and this information should include the consequences in all aspects related to the quality of life post-intervention. In this regard, alternative approaches to transapical/transaortic access in poor candidates to transfemoral access should be evaluated; transaxillary approach is a very good option with fewer induced comorbidities for the patient [9], but the investigation from Tokarek et al [6] makes us wonder if we have enough information regarding the perception of the patient with this approach as compared to others. Additionally, more than 80% of the patients with prior sternotomy had undergone coronary artery bypass grafting.…”

mentioning

confidence: 99%

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

Amat‐Santos¹,

Catalá²

2018

Kardiol Pol

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Article Tokarek et al., see p. 838The spread of transcatheter aortic valve implantation (TAVI) technologies to alternative scenarios in the near future is unquestionable, but several shortcomings still exist. The so-called "TAVI fever" has often led to the use of this promising technology in clinical conditions with unproven efficacy attending to current scientific evidence. Very old [1], multi-valvular [2][3][4], or oncological patients [5] represent some of the challenging scenarios where the use of TAVI might be attractive but remains empirical. Tokarek et al.[6] explored one important scenario still under-investigated despite the fact that one in four TAVI recipients present this condition: the presence of prior sternotomy for cardiac surgery.It is well-known that sternotomy is relatively safe by itself but not harmless [7]. Interestingly, the authors performed not only an assessment of prognostic outcomes, but they also gave a hint of the patient's perception of the procedure through prospective evaluation with quality-of-life scales. This has particular value in comparing conventional cardiac surgery and transcatheter technologies in a population that have experienced both kinds of procedures. Despite the relatively small sample, significant differences were found in global mortality, favouring TAVI in the long term. Also, better results in all evaluated items regarding quality of life (mobility, self-care, pain, etc.) were present, although statistical significance was not reached. The fact that ~20% of the patients were treated through transapical/transaortic approach should be taken into consideration to explain this. In the current series, this proportion is usually below 10% and, even though the authors suggest that both transapical and transfemoral approaches are reasonable in patients with previous cardiac operations, we should keep in mind that the transapical approach also requires a thoracotomy, which has been previously associated with a higher degree of discomfort for the patient, more periprocedural complications, and higher mortality [8]. As highlighted by the authors (and this is the main message from this work, from my perspective), we need to start wondering which alternatives are preferred by well-informed patients; and this information should include the consequences in all aspects related to the quality of life post-intervention. In this regard, alternative approaches to transapical/transaortic access in poor candidates to transfemoral access should be evaluated; transaxillary approach is a very good option with fewer induced comorbidities for the patient [9], but the investigation from Tokarek et al. [6] makes us wonder if we have enough information regarding the perception of the patient with this approach as compared to others. Additionally, more than 80% of the patients with prior sternotomy had undergone coronary artery bypass grafting. Probably, left subclavian approach was not used due to the risk of compromising the left internal mammary artery, whereas the right approach is empi...

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Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral

Abstract: Our study suggests that TSc approach may be, not only an alternative route to TF approach for TAVI, but even a competitive one in certain patients with increased risk of femoral injury.

Cited by 43 publications

References 43 publications

The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures

The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures

Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

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